Gliederung

Background: Network meta-analyses (NMA) are increasingly common in clinical guidelines. NMAs are useful when there is no evidence directly comparing interventions of interest (indirect treatment comparison; ITC), or when combining direct and indirect evidence (multiple treatment comparison; MTC). Well conducted NMAs help guideline committees make transparent and coherent decisions.

Objectives: To assess the content and quality of NMAs within clinical guidelines.

Methods: We systematically identified all NMAs in published clinical guidelines for England and Wales, and undertook a descriptive survey of their features, including: characteristics of the decision problem, construction and complexity of the network, and method of quantitative synthesis. We used a reviewers’ checklist, developed by the NICE Decision Support Unit, to consider the adequacy of the NMA in answering the decision problem.

Results: We included nine published clinical guidelines that have used NMA for one or more decision problems. Five performed MTC (and presented the network) and five performed ITC. All used the results to populate a health-economic model. NMAs in more recently published guidelines were more likely to be MTCs, had clearer descriptions of the networks and methods used, and had more thorough post-estimation diagnostics.

Discussion: The value of NMAs is to make explicit the decisions made implicitly when multiple pairwise comparisons are presented to decision-makers, but developers should be explicit about their assumptions.

Implications for guideline developers/users: Developers should conduct NMAs according to published standards. Further research on the circumstances in which NMAs should be considered would be valuable.